SOAP Notes

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Patient's Phone *

PHASE 1 – PROVIDER & VISIT CONTEXT

Provider Role *

Provider Name *

Supervising Provider *

Visit Type *

Procedure Category *

PHASE 2 – SUBJECTIVE

Body Concerns *

Other Body Concerns *

Facial Concerns *

Other Facial Concerns *

Scarring Concerns *

Other Scarring Concerns *

Injectable Goals *

Other Injectable Goals *

Wellness Goals *

Other Wellness Goals *

PHASE 3 – OBJECTIVE

Fitzpatrick Skin Type *

Treated Areas *

Severity *

Photos *

Upload Photos

Contraindication Status *

Contraindications *

PHASE 4 – ASSESSMENT

Assessment Statement *

PHASE 5 – PLAN

Modalities *

Body Sculpting Device Used *

Body Sculpting Protocols *

Body Sculpting Intensity *

Body Sculpting Duration (Minutes) *

Body Sculpting Cycles *

Body Sculpting Endpoint *

Facial Type *

Active Product Applied *

Facial Device Used *

Facial Protocol *

Facial Passes / Layers *

Facial Endpoint *

Invasive Procedure Type *

Invasive Tool Used *

Adjunct Product Used *

Adjunct Dose *

(ml or mg)

Invasive Protocols *

Invasive Endpoint *

Injectable Type *

Injectable Product *

Injectable Total Dose (Units) *

Injectable Sites *

Injectable Technique *

Injectable Lot # *

Injectable Exp. Date *

Anesthesia Used *

Anesthesia Product *

Anesthesia Dose *

(ml or % as documented)

PHASE 6 – OUTCOME & FOLLOW-UP

Complication Level *

Complication Details *

Follow-Up *

Provider Signature *

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